Background: Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. Methods: Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope^®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. Results: Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. Conclusion: The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.

Patellar sleeve fractures, though relatively rare, present unique challenges in diagnosis and management. This review aims to provide a comprehensive overview of the current understanding of patellar sleeve fractures, focusing on their epidemiology, clinical presentation, imaging, and management strategies. Epidemiologically, these fractures are uncommon, representing approximately 1% of all fractures in pediatric patients, yet they account for 50% of all patella fractures in this population. They predominantly affect adolescents, with a peak incidence around 12.7 years of age, and are more common in boys, occurring at a ratio of 3 to 5:1. Understanding these demographic patterns is crucial for early recognition and appropriate management. Clinically, patellar sleeve fractures typically present with the sudden onset of severe pain, often associated with explosive activities such as jumping. However, diagnosis can be challenging, particularly in cases with minimal displacement or where alternative muscle groups compensate for the injury. Differential diagnosis is essential, and clinicians should be vigilant for signs such as palpable gaps at the lower pole of the patella and patella alta. Imaging modalities play a vital role in diagnosis, with plain X-rays often revealing no bony damage. Ultrasonography may offer a cost-effective alternative, especially in cases where radiographic findings are inconclusive. Advanced imaging techniques such as MRI can assist in characterizing the extent of the injury and assessing for associated complications. Management strategies encompass a spectrum of approaches, ranging from conservative measures such as immobilization and physical therapy to surgical interventions, including open reduction and internal fixation or arthroscopic surgery. The choice of treatment depends on various factors, including the fracture pattern, displacement, patient age, activity level, and associated injuries. Despite advancements in diagnosis and treatment, the optimal management of patellar sleeve fractures remains a clinical challenge. Further research is warranted to elucidate optimal algorithms for diagnosis and treatment, with the ultimate goal of improving outcomes and reducing the risk of long-term complications associated with this rare but clinically significant knee injury.

Since their launch on the market in the late 1970s, Dual Mobility Cups (DMCs) have shown encouraging results both in terms of stability and of restoration of wide hip joint amplitude. Therefore, the use of DMCs is mainly indicated for patients at risk of dislocation, such as those with neuro-muscular diseases, femoral neck fractures, or complex situations like failed hip osteosynthesis, as well as being indicated in the setting of revisions.The objective of this review is to provide indications and recommendations for orthopedic surgeons using DMCs in complex primary and revision settings. An overview of the tech- nical and theoretical requirements necessary to achieve a successful DMC implantation is presented. According to the literature, indications have been expanded thanks to the constant improvement and development of materials and implants. Nowadays, the use of DMCs is no longer limited to revision surgery alone; on the contrary, increasingly complex cases may be approached. Long-term studies are needed before any formal conclusions can be drawn an before the promising results that have been obtained in difficult cases are consolidated.

Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN). Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded. Results: DASH scores improved in both groups at the 6-month follow-up (p < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union (p = 0.001) and return to sporting activities and work (p = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group. Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications.

Objectives: Tibial shaft fractures (TSFs) represent the most common diaphyseal fractures in adults. The gold-standard treatment is intramedullary nailing. Recently, the suprapatellar technique has been increasingly adopted due to its ability to reduce complications associated with the infrapatellar approach. Currently, no clinical score for leg fractures comprehensively assesses the entire lower limb. Therefore, we reviewed the main lower-limb scores available in the literature and developed a new clinical evaluation tool for tibial shaft fractures. The aim of our study was to report our experience with both techniques, to compare the outcomes of our prospective study with the international literature, and to propose a new, easy-to-apply, and reproducible clinical score that evaluates the specific functions of the entire lower limb. Methods: We conducted a prospective analysis of 920 tibial shaft fractures treated with intramedullary nailing via either a suprapatellar or infrapatellar approach. Patients were divided into two groups: Group A, including 420 patients treated with the infrapatellar approach; Group B, including 500 patients treated with the suprapatellar approach. Follow-up included clinical and radiographic assessments at 1, 3, and 6 months, and annually thereafter. We evaluated differences in patient positioning, operation time, radiation exposure, healing rate, incidence of pseudarthrosis and infection, return to ambulation, residual knee pain and fracture site, persistent lameness, and deformities. For the clinical assessment, we devised a new score—the Catania Hospital Score (CHS)—by integrating the most relevant clinical items from existing lower-limb evaluation tools. The CHS includes anterior knee pain (20 points), lameness (5 points), swelling (10 points), stair-climbing ability (10 points), tibial pain (15 points), the ability to perform daily activities (20 points), and evaluation of deformities (varus/valgus, shortening, rotation, and recurvatum/procurvatum (40 points)), for a total of 120 points. Results: Statistically significant differences were observed in Group B regarding a shorter surgical time, a reduced patient positioning time, and decreased radiation exposure. The CHSs were significantly better for Group B at the 3- and 6-month follow-ups. No statistically significant differences were found in infection or pseudarthrosis rates between the two groups. Notably, no cases of chronic knee pain were reported in patients treated with the suprapatellar approach. Conclusions: Both surgical approaches are valid and effective. However, our findings indicate that the suprapatellar approach reduces the complications of the infrapatellar technique, improves postoperative outcomes, and does not result in chronic knee pain. The CHS provides a comprehensive, practical, and reproducible tool to assess functional recovery in patients treated with intramedullary tibial nailing.

Ankle arthrodesis is a commonly used salvage procedure in the management of post-traumatic ankle fractures, which often result in severe disability and may require the amputation of the distal third of the leg. Successful ankle arthrodesis relies on a thorough assessment of local and systemic risk factors to ensure optimal results. Failure to accurately assess these factors may lead to unsatisfactory results. High-energy trauma causing bone defects and soft tissue necrosis often results in osteomyelitis, a condition that poses a significant threat to the success of the arthrodesis procedure. It is important to apply a standardised surgical protocol to minimise the possibility of superficial and deep infection and limit damage to the neighbouring soft tissues. Therefore, it is critical to undertake surgical lavage and debridement and administer systemic and local antibiotic therapy, along with the use of a spacer, to eradicate infection prior to performing arthrodesis. In this study, we present our experience in the recovery of limbs with post-traumatic complications via tibio-astragalic or tibio-calcaneal arthrodesis using a retrograde intramedullary nail technique. The approach involves a multi-step procedure using a previous antibiotic spacer implant and an autologous bone graft (RIA). This study spanned a period from January 2014 to December 2021 and included 35 patients (12 women and 23 men) with a mean age of 47.8 ± 20.08 years (range: 22–85 years). Among the patients, 18 had osteomyelitis following AO 43 C3 fractures, and 9 of them had previous exposure and bone loss at the time of injury. The remaining cases included 10 patients with AO 44 C fracture outcomes and 7 patients with AO 44 B fracture outcomes. Our results emphasise the importance of the meticulous management of local and systemic risk factors in ankle arthrodesis procedures. The successful eradication of infection and subsequent arthrodesis can be achieved via the implementation of surgical lavage, debridement, and systemic and local antibiotic therapy using spacers. This surgical protocol implemented by us has yielded excellent results, saving affected limbs from post-traumatic complications and avoiding the need for amputation. Our study contributes to the existing knowledge supporting the use of retrograde arthrodesis with intramedullary nails in severe cases where limb salvage is the primary goal. However, further research and long-term follow-up studies are needed to validate these results and evaluate the effectiveness of this technique in a larger patient population.